Infectious Dirorder

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  • 1. Pulmonary T.B Pneumonia Lung Abscess Influenza Presenter: Shahina Amiry Sr. Instructor AKUSON
  • 2.
    • Definition:
    • TB is a bacterial infection caused by Mycobacterium tuberculosis. It most commonly affects the lungs, producing pulmonary TB.
    • Cause:
    • Gram +ve Mycobacterium
    • tuberculebacilli.
    06/07/09 www.health-nurses-doctors.com
  • 3. Pathophysiology
    • Susceptible person inhaled the organism
    • The organism settles in the alveoli and multiply
    • The organism may also transport through blood stream and lymph system to other parts of the body
    • The body immune system respond by initiating inflammatory process and phagocytes take place
    • The tissue reaction causes accumulation of the exudates into the alveoli and causes bronchopneumonia
    06/07/09 www.health-nurses-doctors.com
  • 4.
    • Granulomas are formed which transformed into the fibrous tissues
    • The bacteria and macrophages become necrotic and form the cheesy mass
    • Compromised and inadequate immune response, re-infection and activation of dormant bacteria develop active disease
    • Ghon tubercle ulcerate and cheesy material releases into bronchi and bacteria become airborne and cause active tuberculosis
    • Scar tissue form
    06/07/09 www.health-nurses-doctors.com
  • 5. 06/07/09 www.health-nurses-doctors.com
  • 6. Risk factors & Transmission
    • Airborne droplet during coughing, sneezing, spitting, talking, laughing, singing.
    • History of TB, personally, or amongst friends or family.
    • Migration from a country with a high incidence of TB.
    • History of travel to an area with a high incidence of TB.
    • Alcohol and/or drug abuse.
    • Compromised immunity due to illness, e.g., HIV infection.
    • Malnutrition
    • Over crowd
    06/07/09 www.health-nurses-doctors.com
  • 7. 06/07/09 www.health-nurses-doctors.com
  • 8. SIGN AND SYMPTOM 06/07/09 www.health-nurses-doctors.com
  • 9. Diagnostic test
    • Tuberculin skin test QuantiFERON-TB Gold test
    06/07/09 www.health-nurses-doctors.com
  • 10. Treatment: 06/07/09
  • 11.
    • Medications:
    • Primary Agents Secondary Agents
    • isoniazid* capreomycin
    • ethambutol cycloserine
    • pyrazinamide (PZA) ethionamide
    • rifampin kanamycin
    • Streptomycin para-aminosalicyclic acid (PSA)
    • *most frequently used
    06/07/09 www.health-nurses-doctors.com
  • 12. Side Effects of Medication 06/07/09 www.health-nurses-doctors.com
  • 13. NURSING PRIORITIES
    • 1. Achieve/maintain adequate ventilation/oxygenation.
    • 2. Prevent spread of infection.
    • 3. Support behaviors/tasks to maintain health.
    • 4. Promote effective coping strategies.
    • 5. Provide information about disease process/prognosis and
    • treatment needs.
    06/07/09 www.health-nurses-doctors.com
  • 14.
    • Diagnosis:
    • Infection, risk for spread/reactivation
    • Airway Clearance, ineffective
    • Nutrition: imbalanced, less than body requirment
    • Knowledge, deficient regarding condition, treatment, prevention, self-care, and discharge needs
    06/07/09 www.health-nurses-doctors.com
  • 15.
    • Infection, risk for spread/reactivation
    • Instruct patient to cough/sneeze and expectorate into tissue and to refrain from spitting.
    • Proper disposal of tissue and good hand washing techniques.
    • Identify individual risk factors for reactivation of tuberculosis
    • Awareness of transmission possibilities help patient take steps to prevent infection of others.
    • Note: AFB can pass through standard masks; therefore, particulate respirators are required.
    06/07/09 www.health-nurses-doctors.com
  • 16.
    • Assess respiratory function, e.g., breath sounds, rate, rhythm, and depth, and use of accessory muscles.
    • Note ability to expectorate mucus/cough effectively, document character, amount of sputum, presence of hemoptysis.
    • Place patient in semi- or high-Fowler’s position.
    • Assist patient with coughing and deep-breathing exercises.
    • Clear secretions from mouth and trachea; suction as necessary.
    • Maintain fluid intake of at least 2500 mL/day unless contraindicated
    • Provide oral care before and after respiratory treatments.
    06/07/09 www.health-nurses-doctors.com
  • 17. Nutrition: imbalanced, less than body requirements
    • Document patient’s nutritional status on admission
    • Encourage selection/ingestion of well-balanced meals.
    • Ascertain patient’s usual dietary pattern, likes/dislikes.
    • Encourage small, frequent meals with foods high in protein and carbohydrates.
    • Monitor I&O and weight periodically.
    • Investigate anorexia and nausea/vomiting, and note
    • possible correlation to medications.
    • Monitor frequency, volume, consistency of stools.
    06/07/09 www.health-nurses-doctors.com
  • 18.
    • Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered.
    • Aids in monitoring the effects of medications and patient’s response to therapy.
    • Monitor laboratory studies, e.g., sputum smear results; Liver function studies, e. g., AST/ALT.
    06/07/09 www.health-nurses-doctors.com
  • 19. Discharge Teaching 06/07/09
  • 20. 06/07/09 Summarization www.health-nurses-doctors.com
  • 21. 06/07/09 www.health-nurses-doctors.com
  • 22. PNEUMONIA
    • Pneumonia is an Inflammation of alveoli and lungs parenchyma associated with a marked increase in interstitial and alveolar fluid.
    06/07/09 www.health-nurses-doctors.com
  • 23. Causes and Risk factor
    • Bacterial (s.aureus, streptococcus, hemophilus influenza, pseudomonas)
    • Viral
    • Fungi
    • head injury or general anesthesia
    • Exposure to chemicals
    • Tracheal intubation
    • Immuno-suppression(AIDS)
    • Aspiration of food, fluids or vomitus.
    06/07/09 www.health-nurses-doctors.com
  • 24.
    • Bedridden, paralyzed, or unconscious
    • Chronic diseases (diabetes & heart failure)
    • Chronic obstructive pulmonary disease.
    • Very young and very old
    06/07/09 www.health-nurses-doctors.com
  • 25. Pathophysiology organism Susceptible host pneumonia Organism via blood 06/07/09 www.health-nurses-doctors.com
  • 26. Pathophysiology
    • Inhalation of pathogen and harmless bacteria enter into the lower reparatory tract
    • Inflammatory reaction occurs in the alveoli and produces an exudates that interfere with diffusion of oxygen and carbon dioxide.
    • The WBCs especially neutrophills migrate to alveoli and fill the air containing space
    • The area of the lungs are not adequately ventilated because of secretion and mucosal edema
    • Hypoventilation
    • Arterial hypoxemia
    06/07/09 www.health-nurses-doctors.com
  • 27. 06/07/09 www.health-nurses-doctors.com
  • 28. Sign and symptoms
    • * Productive cough Fever & chills
    • Dyspnea Sweating
    06/07/09 www.health-nurses-doctors.com
  • 29. Less common sign & symptoms
    • Fatigue
    • Rapid breathing and heart beat
    • hemoptysis
    • Chest pain
    • Nausea, vomiting, and muscle aches
    • Loss of appetite
    06/07/09 www.health-nurses-doctors.com
  • 30. Pneumonia by Location in the Lung
    • Lobar Pneumonia
    • Bilateral Pneumonia
    • Segmental Pneumonia
    • Bronchopneumonia
    • Interstitial Pneumonia
    • Alveolar Pneumonia
    • Necrotizing Pneumonia
    06/07/09 www.health-nurses-doctors.com
  • 31. Pneumonia by Origin of Infection
    • Community-Acquired Pneumonia (CAP):
    • Most common causes of bacterial CAP is Streptococcus pneumonia
    • Hospital-Acquired Pneumonia. Staphylococcus aureus
    • Aspiration Pneumonia
    06/07/09 www.health-nurses-doctors.com
  • 32. Diagnostic evaluation
    • Medical history Physical examination
    • Chest X-ray CBC /ABGs
    • Culture of Sputum.
    06/07/09 www.health-nurses-doctors.com
  • 33. Treatment
    • Medical management
    • Hospitalization Antibiotic therapy
    • Nebulization
    06/07/09 www.health-nurses-doctors.com
  • 34. Nursing Process
    • Assessment:
    • History
    • Physical examination
    06/07/09 www.health-nurses-doctors.com
  • 35. Nursing Diagnosis
    • Ineffective airway clearance related to copious tracheobronchial secretions.
    • Impaired Gas Exchange related to altered oxygen-carrying capacity of blood
    • Activity intolerance relate to Imbalance between oxygen supply and demand.
    • Altered nutrition less than body requirement
    06/07/09 www.health-nurses-doctors.com
  • 36.
    • Respiratory Isolation
    • Promote airway patency
    • Maintain hydration
    • Perform chest protocol
          • Deep breathing exercise
          • Chest Physiotherapy
          • Use of spirometer
          • Suction
          • Postural drainage
    06/07/09 www.health-nurses-doctors.com
  • 37.
    • Maintain accurate intake and output.
    • Administer antipyretics and antibiotics on timely manner.
    • Encourage the low energy utilization activities.
    • Observe color of skin, mucous membranes, and nail beds, noting presence of peripheral cyanosis
    06/07/09 www.health-nurses-doctors.com
  • 38. Instruct Parents on Discharge
      • About medication administration
      • Increase fluids intake
      • Humidified air
      • Signs and symptoms of respiratory distress
      • Postural drainage techniques
      • Follow care Complications
    06/07/09 www.health-nurses-doctors.com
  • 39. 06/07/09 www.health-nurses-doctors.com
  • 40. Definition
    • Lung abscess is Collection of pus within lungs.
    06/07/09 www.health-nurses-doctors.com
  • 41. CAUSES
    • Bacteria
    • Fungi
    • Commonest cause is aspiration
    • Unconscious or very drowsy because of sedation, anesthesia, alcohol or drug abuse, or a disease of the nervous system (CVA).
    06/07/09 www.health-nurses-doctors.com
  • 42. Pathophysiology
    • Lung infection (infectious agent) causes collection of pus
    • Pus form cavity that is formed by the necrosis of the lung tissues
    • Fibrosis tissue form around the abscess to wall it off
    • Erosion of abscess in the bronchial system causes fouls smell sputum
    06/07/09 www.health-nurses-doctors.com
  • 43. Sign And symptoms
    • Chills
    • Fever
    • Foul smell cough
    • Shivering
    • Night sweat
    • Purulent sputum
    06/07/09 www.health-nurses-doctors.com
  • 44. Diagnostic Evaluation
    • Medical history
    • Blood test
    • Chest x-ray
    • CT as needed
    • Sputum cultures
    • Bronchoscopy as needed to exclude cancer
    06/07/09 www.health-nurses-doctors.com
  • 45. Management
    • Antibiotics (penicillin, cephalosporin)
    • Oxygen may be given to patients who are having trouble breathing.
    • Drainage or aspiration of abscess through bronchoscopy.
    • Pulmonary resection (lobectomy) very rare
    06/07/09 www.health-nurses-doctors.com
  • 46. Nursing Management
    • Emphasize on compliance
    • Teach coughing exercise
    • Chest physiotherapy
    • Frequent mouth care
    • Provide adequate rest, good nutrition and increase fluid intake
    • High protein high caloric diet.
    06/07/09 www.health-nurses-doctors.com
  • 47. INFLUENZA
  • 48.
    • Definition :
    06/07/09 www.health-nurses-doctors.com
  • 49. Prevalence / Epidemiology
    • 2003 Large outbreak of influenza A(H5NI) or avian flu spread among poultry in Asia.
    • By 2004 humans had infected in nine countries.
    • Influenza differs from common cold primarily in its sudden onset and widespread occurrence in population.
    06/07/09 www.health-nurses-doctors.com
  • 50. Types
    • Influenza A ;
    • Responsible for regular outbreaks, including the one of 1918. Influenza A viruses also infect domestic animals (pigs, horses, chickens, ducks) and some wild birds
    • Influenza B: causes localized out, especially in residential communities like nursing homes.
    • Influenza C :common but cause fewer symptoms
    06/07/09 www.health-nurses-doctors.com
  • 51. Causes / Risk Factors
    • Spreads from person to person through respiratory droplets from coughing and sneezing
    • Occasionally from touching something with virus on it and then touching mouth or nose
    06/07/09 www.health-nurses-doctors.com
  • 52.
    • Adults may be able to infect others 1 day before getting symptoms and up to 7 days after getting sick
    • Immunocompromised
    • Resident of chronic care facility and health care worker
    06/07/09 www.health-nurses-doctors.com
  • 53. Signs and Symptoms 06/07/09 www.health-nurses-doctors.com
  • 54. Diagnostic Evaluation
    • CBC, CXR
    • Throat swab for culture
    06/07/09 www.health-nurses-doctors.com
  • 55. Management
    • Interventions are based on manifestation as they arise.
    • Vaccination (70-90 effective) must be given in mid October
    • Antiviral drugs
    • Antibiotics
    • Anti-pyretic
    06/07/09 www.health-nurses-doctors.com
  • 56. Nursing Management
    • Highly contagious disease*
    • Respiratory isolation
    • Promote Rest
    • Adequate Hydration
    • Promote airway patency (chest Protocol)
    • Assess for high risk from complications of the flu such as people 65 years or older, people with chronic medical conditions, pregnant women and young children.
    06/07/09 www.health-nurses-doctors.com
  • 57. 06/07/09 www.health-nurses-doctors.com
  • 58. 06/07/09 www.health-nurses-doctors.com